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Haematology > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

How are Haematological malignancies classified?

A

=> Acute Myeloid Disorders:

  • Acute Myeloid Leukaemia

=> Acute Lymphoid Disorders:

  • Acute Lymphoblastic Leukaemia

=> Chronic Myeloid Disorders:

  • Chronic Myeloid Leukaemia
  • Myeloproliferative Neoplasma
  • Myelodysplastic Syndrome

=> Chronic Lymphoid Disorders:

  • Chronic Lymphocytic Leukaemia
  • Non Hodgkins Lymphoma
  • Hodgkins Lymphoma
  • Myeloma
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2
Q

What is Leukaemia?

A

A generic term used for the cancer of white blood cells

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3
Q

What cells arise from the myeloid lineage?

A

=> Granulocytic cells:

  • Eosinophils
  • Basophils
  • Neutrophils
  • Monocytes
  • Erythrocytes
  • Mast cells
  • Platelets
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4
Q

What cells arise from the lymphoid lineage?

A
  • B Cells
  • T Cells
  • Natural Killer Cells
  • Plasma Cells
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5
Q

What is the pathophysiology of Leukaemia?

A
  • Genetic mutations of haematopoetic stem cells or early progenitor cells
  • Clonal expansion of these abnormal cells due to survival or proliferative advantage
  • Accumulation of these cells leads to transformation to leukaemia
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6
Q

In what gender is Acute Myeloid Leukaemia most prevalent?

A
  • Male

- Most common form of acute leukaemia

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7
Q

What is the pathophysiology of Acute Myeloid Leukaemia?

A
  • Proliferation and arrested maturation of myeloid blast cells in the bone marrow
  • These cells accumulate in the bone marrow, resulting in bone marrow failure as there is less space for normal cells
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8
Q

From what conditions may Acute Myeloid Leukaemia arise from?

A
  • Myelodysplastic Syndrome
  • Myeloprolifertaive Neoplasm
  • Chronic Myeloid Leukaemia
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9
Q

What are the clinical features of Acute Myeloid Leukaemia?

A

As a result of anaemia => pallor, lethargy, weakness
As a result of neutropenia => frequent infections
As a result of thrombocytopenia => bleeding
As a result of metastasis => organmegaly, gum hypertrophy, skin involvement

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10
Q

What are the investigations in suspected Acute Myeloid Leukaemia?

A

=> Bloods
- Thrombocytoenia and Neutropenia due to arrest of maturation. WCC may be raised, normal or low, therefore bloods are not a definitive diagnosis tool

=> Peripheral blood smear
Auer rod in myeloid blast cells only seen in AML

=> Bone Marrow Biopsy

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11
Q

What is the management of Acute Myeloid Leukaemia?

A
  • Prophylactic treatment of infection
  • Supportive care
  • Chemotherapy: Anthracycline, Cytarabine
  • Bone Marrow Transplant
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12
Q

What is Acute Lymphoblastic Leukaemia?

A
  • Most common malignancy in children

- Accumulation of lymphoid blast cells which were meant to mature into B and T cells

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13
Q

What are the clinical features of Acute Lymphoblastic Leukaemia?

A

=> May see Bone Marrow Failure:

Due to anaemia => pallor, lethargy
Due to neutropenia => frequent or severe infections
Due to thrombocytopenia => easy bleeding and bruising

=> Other features due to infiltration:

  • Bone pain
  • Hepatosplenomegaly
  • Fever
  • Testicular swelling

Thrombocytopenia, Neutropenia and anaemia is seen due to the build up of these mutated immature myeloblast or lymphoblast (in this case) cells in the bone marrow, causing normal cell death as the abnormal cells compete with normal cells for nutrients.

=> WCC MAY be raised

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14
Q

What are the investigations in suspected Acute Lymphoblastic Leukaemia?

A

=> Bloods
- Lymphoid markers help differentiate from AML

=> Serum electrolytes
Elevated Ca, PO4, K, uric acid, lactic acid

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15
Q

What is the management of Acute Lymphoblastic Leukaemia?

A
  • Supportive
  • IV antibiotics for prophylaxis
  • Chemo for 2-3 years, Intrathecal methotrexate
  • Bone marrow transplant
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16
Q

What is the pathophysiology of Chronic Myeloid Leukaemia?

A

=> Philidelphia chromisome

  • Translocation between the long arms of chromosomes 9 and 22
  • ABL-protoncogene on chromosome 9 fuses with BCR gene from chromosome 22
  • BCR-ABL gene codes for a fusion protein which causes overactivity in tyrosine kinase
17
Q

What are the clinical features of Chronic Myeloid Leukaemia?

A
  • Anaemia
  • Weight loss and sweating
  • Splenomegaly - may cause abdominal discomfort
  • Increase in granulocytes at different stages of maturation
18
Q

What are the investigations in suspected Chronic Myeloid Leukaemia?

A

=> Bone Marrow Biopsy
- Granulocytic hyperplasia. Increased in number of partially mature granulocytes

=> Bloods and blood smear:

  • Hb and platelets may be normal or reduced
  • Possible increase in number of granulocytes
  • Pseudo Palger Huet cells

=> Chromosomal analysis - FISH
- Philidelphia chromsome

19
Q

What is the management of Chronic Myeloid Leukaemia?

A

1st line treatment => Inatinib

- Considered for stem cell transplant

20
Q

What is Chronic Lymphocytic Leukaemia?

A

Caused by monoclonal proliferation of functionally incompetent lymphocytes,
- Most common form of leukaemia in elderly

21
Q

How are the Chronic Leukaemias different from the Acute Leukaemias?

A

Chronic Leukaemias see rise in partially mature blood cells where as Acute Leukaemias the process of maturation stops. Both types may see varying degrees of cytopenia

22
Q

What are the clinical features of Chronic Lymphocytic Leukaemia?

A
  • Anorexia, weight loss
  • Bleeding
  • Infections
  • Lymphadenopathy more marked

=> Often asymptomatic

23
Q

What staging system is used for Chronic Lymphocytic Leukaemia?

A

Rai Staging

I - Lymphocytosis alone
II - Lymphocytosis + lymphadenoapthy
III - Lymphocytosis + organmegaly
IV - Lymphocytosis + (platelets < 100 x 10^9)

24
Q

What are the complications of Chronic Lymphocytic Leukaemia?

A
  • Anaemia
  • Hypogammaglobinaemia
  • Autoimmune haemolytic anaemia
  • Transformation to high grade lymphoma (Non-Hodgkin’s Lymphoma)
25
Q

What are the investigations in suspected Chronic Lymphocytic Leukaemia?

A

=> Bloods
- High numbers of partially mature lymphocytes

=> Blood films - 1st line
- Smudge cells

=> Bone Marrow Biopsy - Gold Standard

26
Q

What is the management of Chronic Lymphocytic Leukaemia?

A
  • Active surveillance
  • Oral chemo
  • Combination chemotherapy
  • Monoclonal antibodies
  • BCR inhibitors
  • Splenectomy
27
Q

What factors indicate a poor prognosis for Acute Lymphocytic Leukaemia?

A
  • Male sex
  • Age > 2 or < 10
  • WBC > 20 x 10^9/L at diagnosis
  • T or B cell surface markers
  • Non-caucasian
28
Q

What factors indicate a poor prognosis for Acute Myeloid Leukaemia?

A
  • Age > 60
  • > 20% blasts after first dose of chemo
  • Cytogenetics shows deletion of chromosomes 5 or 7

Haematology (17 decks)

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